L.A. health officials brace for fallout from reforms.

County's 3 million unisured residents must get care

Although actual legislation on President Clinton's health care reform package is not expected until next year, Los Angeles County health officials are already gearing up to accommodate up to 3 million uninsured residents that the county's health care system would likely have to treat under Clinton's proposed reforms.

Experts warned that the future of county-owned facilities hangs in the balance, given the Clinton administration's promise to provide universal medical benefits. Providing such care would mean that county facilities, which serve the uninsured, would likely be further overwhelmed.

According to several local experts, Los Angeles County has more uninsured residents than any metropolitan area in the country. Experts estimated that 3 million residents of L.A. County are without health insurance.

If the Clinton administration's promise to provide medical benefits to all becomes a reality, the result could be a decline in the importance of L.A. County-owned hospitals, which serve the uninsured and those with government-subsidized insurance, stated several sources. Other experts, however, predicted that the benefits provided by the county system would prevent a complete oblivion of the system.

Ron Hansen, director of strategic planning for the County of Los Angeles Department of Health Services, said that the fate of county-owned hospitals depends on the ability of L.A.'s private-sector hospitals to serve the huge number of new people that will be eligible for health care under universal coverage.

"We will have to see whether consumers will choose our hospitals when they are given the choice," he said. "That is still a big question."

Most private-sector hospitals in Los Angeles County are operating well under their capacities. According to Thaine H. Allison Jr., an independent health care consultant, the average private-sector hospitals in L.A. is only about 50 percent occupied and is expecting losses on patient care activities. Given that private-sector occupancy is so low, many experts predicted that the private sector would likely be able to service the nearly 3 million uninsured Angelenos that would be eligible for care under Clinton's plan.

Among those predicting universal medical coverage would put a strain on the county's health care system is Robert Burciaga Valdez, associate professor of public health at UCLA.

Two things would happen if we have universal health care coverage, he said. "There will be a shift away from the need for local government plans, like (those offered at) county facilities, and there will be an overload on the system in general."

The Clinton plan, he said, could be a boon to local private-sector hospitals because more people would be able to seek medical attention. He added that, given the choice, most people would move away from care given at county-owned facilities.

Frieda Gehlen, program director for the Education and Health Issues Committee of the Los Angeles Area Chamber of Commerce, pointed out that, although the reforms would bring many more people into the system, Los Angeles County would continue to have a large number of uninsured residents.

It is not likely, she said, that the undocumented workers in Los Angeles County would be covered under health care reform so the need for county facilities would not disappear. "We will need some safety net in the form of public hospitals," she said.

Furthermore, so insure its place in L.A.'s medical future, the county is planning to develop a partnership between public- and private-sector institutions, called a "unified system." As yet, what the unifed system would look like has not been determined. Local health care experts have been meeting since last February to discuss the various possibilites for linking public- and private-sector hospitals and clinics. Sources declined to state exactly how the partnership would be organized given that it is only in the planning stages.

Concerns about cultural sensitivity are also likely to help keep county-owned facilities in business, at least in the short run, according to consultant Allison. The Los Angeles County+University of Southern California Medical Center, for example, which services a predominantly Latino population, staffs its center with many bilingual workers. Much of the literature and many of the signs are bilingual, and the center has developed "sensitivity to cultural concerns that make its Latino patients comfortable," said Allison.

Likewise, said Allison, the Martin Luther King Jr.-Drew Medical Center has developed a relationship with the primarily African-American community it serves. Given the services that people in culturally diverse Los Angeles have come to expect, Allison said he doubts that there will be an abandonment of county facilities. "To the extent that other facilities learn to service these needs, however, they may decide to go elsewhere," Allison said.

Several sources also voiced concerned that Clinton's reform proposals could jeopardize the important role that county-owned facilities play in providing medical education.

Hundreds of doctors and nurses receive training at County+USC and at King-Drew Medical Center. For this educational function alone, county-owned facilities would likely continue playing an active role in the health care industry of Los Angeles.